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Abstract

Background: Hospitals often employ Medical Emergency Teams (MET) to respond to patients with acute physiological decline to prevent in-hospital cardiac arrest (IHCA). However, it is unknown how often patients fail to have a MET evaluation preceding IHCA, and whether these patients have severe vital sign abnormalities suggesting missed opportunities for MET activation.

Methods: Within Get With The Guidelines-Resuscitation, we identified 29,956 patients with IHCA on general inpatient or telemetry floors from 240 hospitals that submitted data on both IHCA and MET evaluations. We determined the proportion without MET evaluation before IHCA. Among those without MET evaluation, we examined the frequency of vital sign abnormalities 1, 2, and 4 hours before IHCA. We used stringent definitions for the following six vital sign abnormalities: heart rate >150 or <30 beats per minute, respiratory rate >35 or <8 breaths per minute, systolic blood pressure <80 mm Hg, and oxygen saturation level of <80%.

Results: Overall, the vast majority (24,733 [82.6%]) of patients with IHCA did not have a preceding MET evaluation. Vital sign data were available for 18,064 patients without MET evaluation. Of these patients, 7109 (39.4%), 5536 (30.6%), and 2368 (13.1%) had at least one severe vital sign abnormality ≥ 1, 2, and 4 hours before IHCA, respectively (TABLE). Furthermore, 13.7% had a Modified Early Warning Score (MEWS) ≥ 4 at least 1 hour before IHCA.

Conclusion: Although MET teams are designed to prevent IHCA, many patients with severe vital sign abnormalities prior to IHCA did not have a MET evaluation. These findings suggest missed opportunities to use MET teams efficiently in hospitals.